MDAEdge · 3 months ago
Senior Manager, Medicare Risk Adjustment Analytics
Denver, CO
Full-time
Onsite
Mid, Senior Level
$100K/yr - $120K/yr
3+ years expMDA Edge is seeking a Senior Manager to lead the Revenue Analytics team responsible for CMS risk adjustment analytics. This role drives the financial and strategic aspects of risk adjustment, providing insights to guide executive decision-making and requires expertise in analytics, finance, and healthcare risk adjustment.
Human Resources
Responsibilities
Lead strategic planning and management of risk adjustment accuracy and revenue optimization
Develop and maintain reports analyzing revenue financials and quantifying the impact of initiatives on Medical Loss Ratio (MLR)
Write SQL queries to extract, manipulate, and analyze clinical operations, medical claims, and encounter data from data warehouses
Ensure all reporting and analytics comply with evolving CMS regulations and policies
Collaborate with clinical, financial, operational, legal, compliance, and IT teams to enhance risk adjustment precision and data integrity
Serve as a subject matter expert on CMS risk adjustment and maintain up-to-date knowledge of HCC models, regulations, and industry developments
Mentor and manage direct reports to build team capability and support professional development
Present analytical findings and business recommendations to senior leadership
Actively contribute to process improvement and operational excellence initiatives
Qualification
Required
Minimum 3 years of professional experience with healthcare data, particularly medical claims or encounter data using SQL
Minimum 3 years of experience in healthcare finance, consulting, medical economics, population health, or related analytics roles
At least 1 year of experience with creation, implementation, and measurement of prospective and retrospective risk adjustment programs (CMS RAPS/Encounter submissions)
Proven experience managing and developing direct reports
Expert knowledge of CMS-HCC models V24 and V28
Strong understanding of the claims data lifecycle, submission systems, and CMS regulations and audits related to risk adjustment
Solid grounding in healthcare economics, value-based care, and population health
Proficiency in SQL and analytics-driven reporting for strategic decision-making
Strategic thinker with intellectual curiosity and problem-solving capability
Strong communicator able to translate complex analytics into clear executive insights
Skilled in managing cross-functional partnerships and collaborating at all organizational levels
Highly adaptable and comfortable navigating change and ambiguity
Entrepreneurial and self-motivated with a focus on continuous improvement
Bachelor's degree required
Preferred
Master's degree preferred
Company
MDAEdge
At MDAEdge, we help our clients reinvent innovation, optimize operations, and reshape perceptions—ensuring they remain at the forefront in today’s fast-evolving world.
51-200 employees
Funding
Current Stage
Growth StageCompany data provided by crunchbase